Concierge - Winter 2014

L I F E , H E A LT H & W E L L N E S S

A PUBLICATION OF

WINTER 2014

“

If you don’t have a

positive outlook,

“

you have nothing.

Network Health Medicare member, Gary Janssen

inside LIFE

Need to Talk to a Nurse?

HEALTH Managing Multiple Medications

WELLNESS Start the New Year off Right

Exclusive Reduced Rate for Network Health Medicare Advantage Members

Danú 20th Anniversary Tour

Thursday, March 12 at 7:30 p.m. Tickets $17.

Log on to www.foxcitiespac.com/onlineoffers before January 18, click on the Network Health logo, select Find Tickets and type MEDICARE in the promo code field. Then purchase your tickets by following the simple instructions that follow.

This offer is only valid for Network Health Medicare members and their families. Not valid on previously purchased tickets. Valid while supplies last.

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life

3 N eed to Talk to a Nurse?

3 Member Appreciation Thank You 4 10 Ways to Avoid Slips and Falls This Winter

health

08

wellness

11 Understand Your Risk for High Blood Pressure 12 Feeling Down?

How to know when it’s more than just the blues 13 Start the New Year off Right

5 Good Questions for Your Good Health

14 Empower Your Health with Emmi®

5 Network Health Medicare Rates High on Quality

15 Provider Directory Changes

6 Help Managing Multiple Medications FEATURE 8 Better Health Starts With Better Support Gary Janssen controls his health with the help of health professionals, friends and family

19 Help with Advance Care Planning New Dental Plans and Hearing Aid Offer BACK COVER Meet Kacey Werner and Your Member Advocate Team Y0108_157_120914 Accepted 12152014

EDITORIAL STAFF

President Chief Administrative Officer Publications Coordinator

Graphic Designer

Sheila Jenkins Penny Ransom Cassie Ashman Debra Sutton

EDITORIAL BOARD Marcia Broeren, Joan Merwin, Angie Keenan, Jeanne Skinner, Melanie Draheim, Dawn Rady, Colleen Davison, Renee Corral, Barb Gore, Chuck Rynearson, Teri Kopeke, Sarah Dencker, Natalie Knaack, Barbara Ott

Concierge is published quarterly by Network Health. The health information contained in Concierge is meant to supplement, not replace, the advice of health care professionals.

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© 2014 Network Health Insurance Corporation. No portion of this newsletter may be reproduced without written permission from Network Health Insurance Corporation.

Network Health Medicare Advantage Plans are MSA and PPO plans with a Medicare contract. NetworkCares is a Coordinated Care Plan with a Medicare contract and a contract with the Forward Health Wisconsin Medicaid Program. Enrollment in Network Health Medicare Advantage plans depends on contract renewal.

The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/ coinsurance may change January 1 of each year. * The products and services described include value-added discounts that are only available to Network Health Medicare Advantage plan members. These discounts are value-added and not part of our Medicare contract or your plan coverage.

NetworkHealthMedicare.com

life Need to Talk to a Nurse?

Call Network Health’s New Nurse Line

S

tarting January 1, 2015, all Network Health Medicare Advantage members will have free access to a new nurse line available 24 hours a day, seven days a week through Health Dialog.

1-888-879-8960

TTY 1-888-833-4271

This new nurse advice line is available to you at no cost. Health Dialog has been providing services to members for over 19 years, and the nurses you’ll speak with can help answer medical care questions specific to you.

Thank You

Every October, we hold our Network Health Medicare Member Appreciation Events.

We love getting the chance to meet our members from all over northeastern Wisconsin.

This year, over 10,000 of you attended to learn more about your benefits and get your flu shot. You asked great questions, and we appreciated that many of you brought a guest so they could learn about Network Health. We hope you also stuck around to see a movie and eat some popcorn. Thanks again to all those who attended. See you again next year.

Here are some examples of when to call.

• When you have a symptom like a sore throat, muscle pain or a fever • When you have questions about your medicines or are prescribed a new medicine and want to know more about it • When you want more information on a health issue • When you need help determining where to go for care and it’s not an emergency

NetworkHealthMedicare.com

Medicare Customer Service Manager

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life

10

Top Ways to Avoid Slips and Falls This Winter T

he falling snow and seasonal decorations make winter a beautiful time of year. Unfortunately, Wisconsin winters also mean icy sidewalks and slippery streets. By taking these precautions, you can avoid slips, falls and injuries.

1

Plan ahead. Ask yourself, “What would I do if I fell?”

2

Take your time. Walk slower and with a wider stance to increase your stability. Don’t be afraid to ask for assistance or a steady arm to hold on to.

3

Wear proper footwear. Shoes and boots should have tread, rubber soles and little or no heels.

Traction devices like Yaktrax® are especially good at preventing slipping.

Get a grip. If you use a cane or walker, consider

purchasing ice-gripping cane tips.

Keep your hands free. Avoid using your cell phone and limit carrying packages when you’re walking so your hands are free and you’re not distracted.

Pay attention to your eyesight. If you wear glasses, make sure the lenses are clean. Allow time for your eyes to adjust from dimness indoors to brightness outside. Don’t proceed if your glasses are fogged.

Keep walkways clear. Clean up puddles from

melted snow and ice immediately to avoid slipping later.

4

5

6

7

your bone health. Make sure to get the 8 Protect proper amount of vitamin D. This isn’t always easy

since we don’t get enough from the sun in winter, so you may need to use supplements.

to maintain strength and balance.

9 Exercise Many of us are less active in the winter. But, we

need to stay strong, steady and flexible to avoid sudden falls and the resulting injuries. Simple exercises can strengthen your upper and lower leg muscles to prevent falls, and help you get up if you do fall.

alcohol. Drinking two or more alcoholic 10 Avoid drinks per day can interfere with your body’s ability to absorb calcium. It can also affect your balance, causing you to be unsteady.

Want to learn more about falls prevention? Consider attending a local Stepping On workshop.

Visit wihealthyaging.org/workshops or call us at 920-720-1655 to find a workshop near you.

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NetworkHealthMedicare.com

health Good Questions for Your Good Health

D

id you know studies show that people who understand health instructions make fewer mistakes when they take their medicine or prepare for a medical procedure? It’s true. Informed patients can even manage a chronic health condition more effectively.

Communication with your doctor is key. And, many health care professionals recommend Ask Me 3™, a patient education program designed to promote communication and improve health outcomes. The program encourages patients to understand the answers to three simple questions.

1. What is my main problem?

2. What do I need to do?

3. Why is it important for me to do this?

Ask questions when—

You see a doctor, nurse or pharmacist.

You prepare for a medical test or procedure.

You get your medicine.

Make sure to ask these three questions next time you discuss your care with your doctor. It can help you be better informed and understand what you need to do to take care of your health.

Network Health Medicare Rates High on Quality Network Health evaluates the quality of care and services provided to members using two nationally recognized tools, the Healthcare Effectiveness and Data Information Set (HEDIS®) and the Consumer Assesment of Healthcare Providers and Systems (CAHPS®). Each tool scores our service in a different way. To view Network Health Medicare Advantage’s results visit NetworkHealthMedicare.com and search for HEDIS® and CHAPS® results. Click the first link that appears in the search results. If you have any questions, or for more information about Network Health’s Quality Improvement Program and national rankings, call 920-720-1229, or toll-free at 800-826-0940, ext. 01229.

NetworkHealthMedicare.com

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health

Help Managing Multiple Medications

F

or Network Health Medicare Advantage members who have several health conditions and take many medications, there’s an increased risk for problems or harmful drug interactions. That’s why we offer a special program to help, called medication therapy management.

WHAT IS MEDICATION THERAPY MANAGEMENT?

This program supports you and your doctor to make sure your medicines are working to improve your health. It’s designed to help you manage several medications and do the following. l Improve your medication use. l Reduce the risk of dangerous drug reactions. l Make sure you’re taking medications correctly and as prescribed. l Ensure you are on the most appropriate and cost effective medications.

WHO IS ELIGIBLE?

To be eligible for the program, you must meet the following three criteria.

1

You must have at least three long-term (also called chronic) medical conditions.

These may include: l Asthma l Chronic heart failure l Chronic obstructive pulmonary disease l Depression l Diabetes l End stage renal disease l High blood fat levels l High blood pressure l Osteoporosis

2

For long-term medical conditions, you must take seven or more daily medicines that are covered by Medicare Part D.

3

Your Part D covered medication must cost more than the CMS specified annual cost threshold.

For 2015, that amount is $3,138.

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LEARN MORE

For more information about the program, or to find out if you qualify, call your health care concierge or 800-378-5234, Monday – Friday, 8 a.m. – 8 p.m. (TTY 800-947-3529).

NetworkHealthMedicare.com

JOINING THE PROGRAM

If you meet the eligibility requirements on the previous page, you’re automatically enrolled in medication therapy management and will receive the following at no cost. l An introductory letter that tells you how to get started. l An offer to participate in a comprehensive medication review each year. l The chance to review your medications with a pharmacist or other health care professional, including over-the-counter drugs and herbal products.

This review will help you get the best results from your medicines. l A letter that outlines this review and suggests next steps. l A targeted medicine review (at least quarterly). l This will provide you and/or your doctor specific

information about making changes to your medication therapy.

KEY THINGS TO KNOW

l l

l l

l

This program is available at no cost.

Members may participate every year that they meet the eligibility requirements.

Participation in the program is voluntary.

Although members will be automatically enrolled, they may choose not to participate.

This is not a benefit of our plan, but rather a voluntary program.

KEEPING A PERSONAL MEDICATION LIST

Having a list of all your medicines will help doctors, pharmacists and hospitals best take care of you.

It can also prevent potential errors or problems. Share your list with family, and if you go to the hospital or emergency room, take your list with you.

KEEP THIS LIST UP-TO-DATE WITH w Prescription medications w Over-the-counter drugs w Herbals w Vitamins w Minerals Use the below as a guide to start your own list. Record this information for each drug you take.

Medication and strength I take How I use it Why I use it Date I started using it

Date I stopped using it

Why I stopped using it For a complete and easy-to-print medication guide, visit NetworkHealthMedicare.com/PersonalMedicationList NetworkHealthMedicare.com

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COVER STORY

“

The other day I talked to Crissy for over an hour.

“

When she calls, I get a different outlook on life.

Do you have COPD?

Network Health offers a special program called Breathe at Ease. It’s uniquely designed to help our members with COPD improve or better manage lung conditions. This program gives members access to a registered respiratory therapist and is available at no additional cost. If you are interested in learning more about Breathe at Ease and how it works, call Robyn West, RRT at 920-831-1498 or 920-738-2558.

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NetworkHealthMedicare.com

BETTER HEALTH STARTS WITH BETTER SUPPORT

It takes a village–how Network Health member, Gary Janssen,

controls his health with the help of health professionals, friends and family.

I

t’s easy to take breathing for granted—it’s just not something most of us have to think about.

Unfortunately, that isn’t the case for people with chronic obstructive pulmonary disease (COPD). COPD is a complex condition that can make something as natural as taking a breath, become a struggle.

When a person is diagnosed with COPD, they know their way of life will have to change. It is a progressive disease and there is no cure. But, COPD can be managed.

And, how a person reacts to his or her diagnosis will play a vital role in overall quality of life.

Gary Janssen was diagnosed with COPD at age 55 and he admits it was a hard adjustment. Gary was working for the City of Kaukauna and even after 36 years, he still felt too young to retire. But, after being put on oxygen, Gary understood he would need to make some changes.

Thankfully, Gary’s boss was very supportive and he

helped Gary find a way to retire early and keep his health insurance coverage. As a City of Kaukauna employee, Gary was covered under a commercial Network Health plan which gave him access to the doctors and specialists he wanted to see.

At age 62, Gary switched over to a Network Health Medicare Advantage plan. Gary explains, “When I met with the agent, I said show me what you got for Network.

I knew I wasn’t going anywhere but with another Network Health plan.”

After talking with his agent, Gary decided to enroll in Network Health’s PlatinumPremier plan. Because the plan is a Preferred Provider Organization (PPO) plan, Gary knew he could continue to see the doctors he had come to know and trust.

Gary’s relationship with his pulmonologist, Dr. Avery, was especially important to him. And making

By Cassie Ashman Photography by Beth DesJardin, Trove Photography NetworkHealthMedicare.com

C oncierge | 9

COVER STORY

Gary with his nurse care manager, Crissy McNaughton

sure he would have access to doctors that knew him well and understood his condition was an important factor in choosing a Network Health Medicare Advantage plan.

“It’s a good peace of mind knowing that you’re covered,” Gary explains.

Another advantage to choosing Network Health, was access to Gary’s own personal nurse care manager. This service is available to all members who qualify for no additional cost. Nurse care managers spend every day helping members coordinate care, giving advice on how to manage conditions and giving tips on how to avoid health problems or complications.

When speaking about his nurse care manager, Crissy McNaughton, Gary says, “She’s on my speed dial. When I’ve got questions about my medicines or care, I know she’ll get the answer for me.” Gary appreciates the time Crissy takes to help him with his care. “The other day I talked to Crissy for over an hour. When she calls, I get a different outlook on life.”

Because dealing with a condition like COPD is a struggle, you need to have a strong team of people around you to offer support. Of course quality nurses and doctors are a big part of that, but so are family and friends.

Gary is fortunate to come from a big family and he 10 | C oncierge

is close with his siblings. In fact, his brother is his best friend. And, Gary also has close relationships with many of his friends and neighbors which keep him going when faced with health challenges.

He explains that spending time with people is important to keeping his spirits high. It would be easy for Gary to focus on the negative—not only has COPD made it difficult for Gary to breathe, but he was also diagnosed with diabetes. Both diabetes and COPD are considered chronic conditions, meaning they’re life long and need to be actively managed.

His conditions have affected his lifestyle. He says “In winter, I’m not as mobile as I’d like to be, but I work around it.” Gary makes it a priority to spend time with family and friends, and every Sunday a server from his church brings him communion. “If you’re living alone, you have to make sure you have local people to talk to. It will change your whole day.”

Gary’s optimistic attitude has not only helped him effectively manage his condition, but it’s also given him a better quality of life. His good-natured personality and sense of humor through challenging times have helped him create a strong support system of health care professionals, family members, neighbors and friends.

NetworkHealthMedicare.com

wellness Understand Your Risk for High Blood Pressure H

igh blood pressure is common among Americans— nearly one in three U.S. adults has high blood pressure according to the American Heart Association.

Unfortunately, this leads to an increased risk for developing serious health conditions, like heart disease and stroke.

Knowing the basics and being informed can help you manage your risk factors and bring blood pressure under control.

What is high blood pressure?

As your heart pumps blood to different parts of your body, blood pushes against the walls of your blood vessels and arteries. The force it exerts is what doctors call blood pressure.

High blood pressure usually has no warning signs or symptoms, so many people don’t realize they have it.

The only way to know if you have high blood pressure is to have a doctor or other health professional measure it.

Measuring your blood pressure is quick and painless.

What causes it?

High blood pressure often has no direct cause, however, certain risk factors may increase your risk of developing it. Age, gender, race and family history are a few factors that cannot be controlled. Fortunately, you can help control many of the others.

What should I do if I have high blood pressure?

It’s important not to ignore it. If left untreated, it can lead to stroke, dementia, heart and kidney problems and impotence. Discuss your target blood pressure with your doctor. Together, you can decide what steps you need to take to achieve what’s healthy for you.

NetworkHealthMedicare.com

How to Control Your Risk Factors •

•

•

•

•

Lose weight. If you’re overweight, losing even five pounds can help lower your blood pressure.

Get active. Regular physical activity can help lower your blood pressure and keep your weight under control.

Don’t use tobacco and limit alcohol. Smoking or chewing tobacco can raise blood pressure. If you smoke, quit. And, only consume alcohol in moderation. Too much alcohol is also a contributing factor of high blood pressure.

Eat a healthy diet. A diet rich in whole grains, fruits, vegetables, low-fat dairy and low in sodium has been shown to help lower blood pressure.

Reduce stress. Stress can raise blood pressure temporarily and may lead to overeating and tobacco or alcohol use. If you often feel overwhelmed or stressed, it’s important to take steps to change that.

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wellness

Feeling Down?

How to Know When It’s More Than Just the Blues

T

he short, dark days can make many of us feel like we’ve caught a case of the winter blues. While slight mood changes can be normal, it’s important to know when it might be something more serious.

Understand What Depression Is

Depression can be caused by a combination of genetic, biological, environmental and psychological factors. According to genetic research, depression can result from genes acting together with environmental factors. Seasonal depression, often called seasonal affective disorder (SAD), is a type of depression that occurs each year at the same time.

Some types of depression run in families, but it can occur in people without family histories. In other cases, trauma can cause depression. Loss of a loved one, career or any other stress can trigger depression. However, some episodes of depression can occur without any obvious triggers, too.

You shouldn’t feel ashamed or embarrassed if you think you’re experiencing depression. Instead, take steps to understand it and know when you should talk to your doctor.

Recognize Symptoms w Persistent sad, anxious or empty feelings w Feelings of hopelessness or pessimism w Feelings of guilt, worthlessness or helplessness w Irritability or restlessness w Loss of interest in activities or hobbies you used to enjoy w Fatigue and decreased energy w Difficulty concentrating, remembering details and making decisions w Insomnia or excessive sleeping w Overeating or appetite loss w Thoughts of suicide or suicide attempts w Aches or pains, headaches, cramps or digestive problems that do not get better even with treatment

Know If You’re At Risk

According to the National Institutes of Mental Health, each year about 6.7 percent of U.S adults experience major depression. Women are 70 percent more likely than men to experience depression during their lifetime.

Fortunately, even in severe cases depression can be effectively treated. And, the earlier treatment begins, the more effective it is. The first step to getting appropriate treatment is to visit a doctor or mental health specialist.

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NetworkHealthMedicare.com

?

Call your health care concierge or 800-378-5234, Monday - Friday, 8 a.m. - 8 p.m. (TTY 800-947-3529)

Start the New Year off Right Y

our mental state can greatly affect your physical health.

It’s not easy to change habits, but by putting the below tips into practice, you’ll notice an improved mood in 2015.

Accept there are things you can’t control.

It’s easy to romanticize the past and wish you could just go back to “the good old days.” But don’t allow yourself to get wrapped up in something that’s out of your power. Instead of comparing the present to the past, try to enjoy the moment and don’t worry about how things used to be.

Keep a positive attitude.

Easier said than done, right? It might be a struggle at first, but it is important to your health. A Boston University study revealed seniors with a positive attitude recover better from surgeries than those with a negative outlook. Being an optimist will make it easier to overcome life’s challenges.

Get and stay socially connected.

Remember, your mental and emotional health are just as important as your physical health. Most people understand they need to take time to exercise and eat right to stay healthy. It’s also important to stay connected socially. Try volunteering or doing something nice for others. Helping out can create a sense of purpose and lead to greater happiness.

NetworkHealthMedicare.com

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wellness

Empower Your ® Health with Emmi New Online Programs Teach Members about Health Conditions

T

he more knowledgeable you are and the more you’re involved in your health care, the more empowered you’ll be to manage your health successfully. That’s why Network Health offers online learning programs that members can take advantage of at no cost.

The new online lessons are available through Emmi, an interactive solution that’s easy to use and helps you actively manage your health. You can view it on your computer, tablet or smartphone. Members who use an Emmi program say it answers many of their questions and helps them feel more comfortable taking care of their health.

Emmi offers tutorials on many different health topics and conditions, and each takes about 30 minutes to complete. See an example below. You can watch the modules at your convenience and as many times as you want.

To get access to an Emmi program, or to learn more about how an Emmi program can help you, call 920-720-1695, Monday through Friday, 8 a.m. – 4:30 p.m. © 2014 Emmi Solutions, LLC Chronic Low Back Pain program

Do you know how health plans make their decisions?

Visit NetworkHealthMedicare.com and click Member’s Corner. Next, look for the Resources heading and click How Health Plans Make Their Decisions. You’ll learn important information about service and appropriateness of care. Or, call 920-720-1602 (TTY 800-947-3529), Monday - Friday, 8 a.m. to 5 p.m. for a hard copy of this information. Bilingual language assistance or translation services are also available.

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NetworkHealthMedicare.com

PROVIDER DIRECTORY CHANGES

u PROVIDER ALSO ACCEPTS MEDICAID W PROVIDER CANNOT BE SELECTED AS A PCP

This insert lists changes to our Provider Directory for our Medicare plans. Provider additions and deletions are listed. Please pay close attention to the deletions— these providers are no longer in our network. The changes listed are changes since July 31, 2014. If you would like to request a complete directory, call your health care concierge or 800-378-5234, Monday through Friday, 8 a.m. to 8 p.m. (TTY 800-947-3529). For current provider information, please visit our website at NetworkHealthMedicare.com, call your health care concierge or the number listed above. Please note these are changes to the specific providers in bold, not entire facilities.

Network Health recognizes the following specialties as Primary Care Providers: Family Practice, General Practice and Internal Medicine.

ADDITIONS ADDICTION PSYCHIATRY SHEBOYGAN Prevea Sheboygan Behavioral Care Baxter, Carolyn J MD u ALLERGY AND IMMUNOLOGY BROWN Prevea Clinic Locke, Bradley DO u BEHAVIORAL HEALTH DODGE Dodge County Human Services Kaspar, Judith R LCSW u ONEIDA St Marys Hospital Pflugardt, Shawn A PsyDu OUTAGAMIE Appleton Medical Center Behavioral Health Normington, Katie L LCSWu Appleton Psychiatric and Counseling Center Forslund, Mary S APNP u SHEBOYGAN Prevea Sheboygan Behavioral Care Hughes, Kathy J LCSW u Lintereur, Mamie E LCSW u CARDIAC ELECTROPHYSIOLOGY MILWAUKEE CSMPC Cardiac Rhythm Specialists Khazi Syed, Rashad MD u OUTAGAMIE CSMPC Cardiac Rhythm Specialists Khazi Syed, Rashad MD u OZAUKEE CSMPC Cardiac Rhythm Specialists Khazi Syed, Rashad MD u SHEBOYGAN CSMPC Cardiac Rhythm Specialists Khazi Syed, Rashad MD u WINNEBAGO NetworkHealthMedicare.com

CSMPC Cardiac Rhythm Specialists Khazi Syed, Rashad MD u CARDIOLOGY/ CARDIOVASCULAR DISEASE OUTAGAMIE Appleton Cardiology Thedacare Sidhu, Jasdeep S MD u Varghese, Cherian J MD u SHAWANO Appleton Cardiology Thedacare Varghese, Cherian J MD u WAUPACA Appleton Cardiology Thedacare Varghese, Cherian J MD u WINNEBAGO Appleton Cardiology Thedacare Varghese, Cherian J MD u CARDIOTHORACIC/ THORACIC SURGERY BROWN Prevea Clinic Shen, Paul M MD u DANE UW Health Surgery Morgan, Angela B PAC u UW Health UW Hospital and Clinics Surgery Morgan, Angela B PAC u OUTAGAMIE Appleton Cardiology Thedacare Augelli, Nicholas V MD u CHIROPRACTIC DODGE Chiropractic USA Espenscheid, Jenifer DC u WINNEBAGO Winneconne Chiropractic and Sports Rehab LLC Kellogg, Alexandra DC u

EAR NOSE AND THROAT/ OTOLARYNGOLOGY DANE UW Health UW Hospital and Clinics Audiology Rottinghaus, Hannah PAC u ENDOCRINOLOGY/DIABETES AND METABOLISM DANE UW Health West Clinic Diabetes Flynn, Maxfield P MD PHD u UW Health West Clinic Endocrinology Flynn, Maxfield P MD PHD u FAMILY PRACTICE BROWN Bellin Health Family Medical Center Spott, Sarah R APNP u Bellin Memorial Hospital Spott, Sarah R APNP u Prevea Clinic Hayward, Pamela M APNP u Bellin Health Family Medical Center Ashwaubenon Quella, Stacy L MD u Bellin Health Family Medical Center Howard Kasper, Alyssa A MD u Prevea Clinic Severance, Katrina DO u Wood, Georgine APNP u CALUMET Thedacare Physicians Darboy Sharma, Deepti MD u Thedacare Physicians Hilbert Sharma, Deepti MD u UW Health Regional Specialty Services Portage Clinic Regala, Mitzi M MD u Wangerin, Joseph J PAC u

DANE UW Health East Towne Urgent Care Aftab, Zahra MD uW UW Health Northeast Family Medical Center Vonk, Jantina R MD uW UW Health West Towne Clinic Urgent Care Aftab, Zahra MD uW UW Health Yahara Swedlund, Matthew P MD u UW Health Verona Clinic Wray, Jason R PAC uW DOOR North Shore Medical Clinic Knipfer, Ellen L APNP u FOND DU LAC Agnesian Work and Wellness Wiersma, Teresa J APNP u CHN Medical Center Quade, Sandralee APNP u GREEN LAKE CHN Medical Center Quade, Sandralee APNP u KEWAUNEE Bellin Health Family Medical Center Algoma Torzewski, Ellen A APNP u OUTAGAMIE Affinity Medical Group Gorenc, Jessica E APNP u Thedacare Physicians North Turnmeyer, Denise L APNPu Vanlannen, Jessica L APNPu Affinity Medical Group Chiu, Albert H DO u Affinity Medical Group Hancock, Jessica L MD u SHEBOYGAN Prevea Sheboygan Family C oncierge | 15

Practice Armendariz, Jose A MD u Olaso, Sarah M MD u WAUPACA Riverside Medical Center Ownby, Kim H PAC u WINNEBAGO Thedacare Physicians Menasha Sharma, Deepti MD u Affinity Medical Group Luangla, Mysee APNP uW Thedacare Physicians Neenah West Potokar, Tina L PAC u Affinity Medical Group Beeson, Matthew F MD u Affinity Medical Group Prucha, Katie L APNP u FOOT SURGERY CALUMET Calumet Medical Center Devries, Jason G DPM u GASTROENTEROLOGY BROWN Prevea Clinic Gorospe, Emmanuel C MD u DANE UW Health Digestive Health Center Zablotney, Monica M APNP u SHEBOYGAN Columbia St Marys Sheboygan Outpatient Center Khiani, Vijay S MD u Prevea Sheboygan Gastroenterology Wolfert, Marla Z MD u GERIATRIC MEDICINE DANE UW Health University Station Clinic Internal Medicine Eastman, Alexis M MD u GERIATRIC PSYCHIATRY SAUK UW Health Specialty Clinic Sauk Prairie Fischer, Barbara L PsyD u SHEBOYGAN Prevea Sheboygan Behavioral Care Baxter, Carolyn J MD u GYNECOLOGIC ONCOLOGY DANE 16 | C oncierge

UW Health Carbone Cancer Center Odonnell, Kelin B PAC u Robillard, Janet A PAC u GYNECOLOGY DANE UW Health UW Hospital and Clinics Gynecology King, Cara R DO u HEMATOLOGY OUTAGAMIE Thedacare Medical Oncology Chaudhary, Vijay MD u Weiss, Matthias MD u WAUPACA Thedacare Medical Oncology Weiss, Matthias MD u INFECTIOUS DISEASE DANE UW Health UW Hospital and Clinics Infectious Disease Kayon, Brian C PAC u INTERNAL MEDICINE BROWN Prevea Clinic Shittu, Maryam MD u DANE UW Health East Towne Internal Medicine Jelenc, Briana L MD u OUTAGAMIE East Wind Healthcare SC Weiner, H Richard MD u Thedacare Physicians Internal Medicine ECH Kagen, Michael A MD u Schoenborn, Jami M APNP u NEONATAL-PERINATAL MEDICINE DANE UW Health UW Meriter Hospital Neonatal Center Wraight, Catherine L MD u UW Health American Family Children’s Hospital Neonatal Inten Wraight, Catherine L MD u NEONATOLOGY DANE UW Health UW Meriter Hospital Neonatal Center Bush, Kelly A MD u Magnuson, Katherine M MD u McBride, Elizabeth B MD u

UW Health American Family Children’s Hospital Neonatal Inten Bush, Kelly A MD u Magnuson, Katherine M MD u McBride, Elizabeth B MD u NEPHROLOGY DANE UW Health Kidney Clinic Waheed, Sana MD u Wisconsin Dialysis Fitchburg Clinic Waheed, Sana MD u Wisconsin Dialysis East Clinic Waheed, Sana MD u NEUROLOGY DANE UW Health UW Hospital and Clinics Neurology Bazalakova, Mihaela H MD u UW Health UW Hospital and Clinics Pediatric Neurology Elkay, Muruvet MD u PORTAGE Ministry Medical Group Rice Clinic Spitzer, Alexander R MD u OBSTETRICS AND GYNECOLOGY BROWN Prevea Clinic Milosavljevic, Jennifer MD u ONCOLOGY COLUMBIA UW Health Regional Specialty Services Divine Savi Kyriakopoulos, Christos MD u DANE UW Health Carbone Cancer Center Kyriakopoulos, Christos MD u OUTAGAMIE Thedacare Medical Oncology Chaudhary, Vijay MD u Marohn, Sally A APNP u Weiss, Matthias MD u WAUPACA Thedacare Medical Oncology Weiss, Matthias MD u OPTOMETRY BROWN Shopko Eyecare Center Kizewski, Erin R OD u Prevea Clinic Isenhart, Jessica OD u

CALUMET Valley Eye Associates Abata, Katie OD u DANE UW Health Deming Way Eye Clinic Steinhauer, Andrew T OD u MANITOWOC Shopko Eyecare Center Kizewski, Erin R OD u MARINETTE Shopko Eyecare Center Kizewski, Erin R OD u OCONTO Shopko Eyecare Center Kizewski, Erin R OD u OUTAGAMIE Valley Eye Associates Abata, Katie OD u Jorgensen Schulz and Associates The Eye Care Center Rosiek, Tracy L OD u Shopko Eyecare Center Kizewski, Erin R OD u SHEBOYGAN Wisconsin Vision Inc Wilson, Joseph OD u WINNEBAGO Shopko Eyecare Center Kizewski, Erin R OD u Valley Eye Associates Abata, Katie OD u ORAL AND MAXILLOFACIAL SURGERY OUTAGAMIE TMJ Treatment Centers LMG Inc Tache, Daniel E DMD u ORTHOPAEDIC SPINE SURGERY BROWN Prevea Clinic Teddy, Shelia PAC u DANE UW Health Research Park Spine Medicine Poliak Tunis, Michelle A MD u ORTHOPAEDIC SURGERY BROWN Prevea Clinic Mc Dougall Schick, Patricia A MD u Severance, Daniel L DO u DANE UW Health UW Hospital and Clinics Orthopedic Surgery Julka, Abhishek MD u NetworkHealthMedicare.com

DODGE Fond du Lac Regional Clinic Zweiger, Cassandra J PAC u FOND DU LAC St Agnes Hospital Zweiger, Cassandra J PAC u Ripon Medical Center Primary Care Services Clinic Meincke Reza, Jeffrey W MD u Zweiger, Cassandra J PAC u MANITOWOC Lakeshore Orthopaedics Goddeyne, Eric PAC u Sylvester, Thomas J MD u PORTAGE Ministry Medical Group Rice Clinic Phelan, Benjamin J PAC u SHEBOYGAN Prevea Sheboygan Orthopaedics Brazzale, Kristen A APNP u St Nicholas Hospital Mc Dougall Schick, Patricia A MD u PAIN MANAGEMENT DANE Madison Surgery Center Abd Elsayed, Alaa A MD u UW Health East Clinic Pain Clinic Abd Elsayed, Alaa A MD u Poliak Tunis, Michelle A MD u UW Health UW Hospital and Clinics Anesthesiology Abd Elsayed, Alaa A MD u MILWAUKEE Advanced Pain Management Gozner, Gerald PAC u Travnicek, Katherine D MD u SAUK Advanced Pain Management Travnicek, Katherine D MD u PHYSICAL MEDICINE AND REHABILITATION DANE UW Health East Clinic Pain Clinic Poliak Tunis, Michelle A MD u PLASTIC SURGERY BROWN Prevea Clinic Sauerhammer, Tina M MD u PODIATRY CALUMET Calumet Medical Center Devries, Jason G DPM u

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MANITOWOC Lakeshore Orthopaedics Snellgrove, Jonathan A DPM u PSYCHIATRY-GENERAL DANE UW Health Behavorial Health and Recovery Clinic Gannage, Melissa A MD u OUTAGAMIE Appleton Psychiatric and Counseling Center Forslund, Mary S APNP u Affinity Behavioral Health Bentham, Wayne D MD u SHEBOYGAN Prevea Sheboygan Behavioral Care Baxter, Carolyn J MD u Olsen, John L MD u PSYCHOLOGY-GENERAL ONEIDA St Marys Hospital Pflugardt, Shawn A PsyD u SHEBOYGAN Prevea Sheboygan Behavioral Care Lukach, Brian M PhD u RECONSTRUCTIVE REARFOOT ANKLE SURGERY CALUMET Calumet Medical Center Devries, Jason G DPM u RHEUMATOLOGY DANE UW Health Rheumatology Dondlinger, Susan M APNP u UW Health West Clinic Rheumatology Dondlinger, Susan M APNP u SLEEP MEDICINE DANE Wisconsin Sleep Lab Bazalakova, Mihaela H MD u SURGERY BROWN St Vincent Hospital Shiley, Janet L MD u DANE UW Health Digestive Health Center Carchman, Evie H MD u UW Health Surgery Steiman, Jennifer G MD u UW Health West Clinic

Vascular Surgery Wepfer, Victoria A APNP u UW Health UW Hospital and Clinics Breast Center Steiman, Jennifer G MD u UW Health UW Hospital and Clinics Surgery Hauser, Michelle R PAC u Nelson, Sarah M APNP u Yeager, Jennifer D APNP u Affinity Medical Group Lady, Ping D MD u SURGERY-HAND DANE UW Health UW Hospital and Clinics Orthopedic Surgery Julka, Abhishek MD u SURGICAL ONCOLOGY DANE UW Health Digestive Health Center Carchman, Evie H MD u Clinics Orthopedic Surgery Julka, Abhishek MD u UROLOGY DANE UW Health Urology Gralnek, Dan R MD u UW Health UW Hospital and Clinics Doerfer, Kristin L APNP u Gralnek, Dan R MD u Richards, Kyle A MD u VASCULAR SURGERY DANE UW Health West Clinic Vascular Surgery Phillips, Cynthia J APNP u DURABLE MEDICAL EQUIPMENT BROWN Bellin Health Home Care Equipment HAMILTON Roche Health Solutions Inc PHYSICAL THERAPY BROWN Oconto Physical Therapy LLC DODGE Advance Physical Therapy and Sports Rehab LLC OUTAGAMIE The Bridges of Appleton

DELETIONS

BEHAVIORAL HEALTH PORTAGE Oswald Counseling Associates Inc Pflugardt, Shawn A PsyD CARDIOLOGY-INTERVENTIONAL OUTAGAMIE Appleton Cardiology Thedacare Alaswad, Khaldoon MD SHAWANO Appleton Cardiology Thedacare Alaswad, Khaldoon MDD WINNEBAGO Appleton Cardiology Thedacare Alaswad, Khaldoon MD CARDIOLOGY/ CARDIOVASCULAR DISEASE DANE UW Health Cardiovascular Medicine Sidhu, Jasdeep S MD UW Health East Clinic Cardiovascular Medicine OUTAGAMIE Appleton Cardiology Thedacare Alaswad, Khaldoon M SHAWANO Appleton Cardiology Thedacare Alaswad, Khaldoon M WINNEBAGO Appleton Cardiology Thedacare Alaswad, Khaldoon M CHIROPRACTIC PORTAGE Lysne Chiropractic Care Lysne, Marshall T DC ENDOCRINOLOGY/DIABETES AND METABOLISM DANE UW Health West Clinic Diabetes Frese, Abby C APNP UW Health West Clinic Endocrinology Frese, Abby C APNP Jaume, Juan C MD OUTAGAMIE Fox Valley Nephrology Partners SC Radich, Roxanne D APNP CNS CDE SHAWANO Fox Valley Nephrology Partners SC

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Radich, Roxanne D APNP CNS CDE WINNEBAGO Affinity Medical Group Cardenas, Maria O MD Fox Valley Nephrology Partners SC Radich, Roxanne D APNP CNS CDE FAMILY PRACTICE UW Health Belleville Family Medical Clinic Massaro, Lana A MD Affinity Medical Group Ashta, Raman MD DANE UW Health Northeast Family Medical Center Massaro, Lana A MD UW Health Arboretum Family Medicine Clinic Sharp, Samantha N MD UW Health Odana Atrium Clinic Sharp, Samantha N MD UW Health Verona Clinic Massaro, Lana A MD EAU CLAIRE UW Health Eau Claire Family Medicine Galewyrick, Kenneth L MD OCONTO Northern Health Centers Inc Dailey, Janet M APNP CMH Oconto Falls Primary Care Clinic Perez, Iris Tc MD OUTAGAMIE Fox Valley Nephrology Partners SC Radich, Roxanne D APNP CNS CDE Affinity Medical Group Mittelstadt, Kim A APNP SHAWANO Fox Valley Nephrology Partners SC Radich, Roxanne D APNP CNS CDE Thedacare Physicians Shawano Cloutier, Vickie M MD WINNEBAGO Affinity Medical Group Ashta, Raman MD Fox Valley Nephrology 18 | C oncierge

Partners SC Radich, Roxanne D APNP CNS CDE Affinity Medical Group Dias, Jose C MD Sports Medicine Center SC Lundgren, Laura M PAC GASTROENTEROLOGY BROWN Gastroenterology Associates Amarnani, Narayan H MD Prevea Clinic Dzwonkowski, Peter MD HEMATOLOGY GREEN LAKE CHN Hematology Oncology Clinic Geller, Robert B MD INTERNAL MEDICINE BROWN Prevea Clinic Lim, Luigi Martin C MD DANE UW Health West Clinic Internal Medicine Dachel, Theresa A APNP UW Health West Clinic Internal Medicine at Women’s Health Stumm, Eleanore K APNP MANITOWOC Holy Family Memorial Internal Medicine and Gastroenterology Stephens, Joanna MD ONEIDA Ministry Medical Group Rhinelander Stephens, Joanna MD NEPHROLOGY DANE UW Health Kidney Clinic Alfonso Jaume, Maria A MD NEUROLOGY DANE UW Health Neurology Tunnell, Evelyn C MD UW Health UW Hospital and Clinics Epilepsy Clinic A Tunnell, Evelyn C MD UW Health UW Hospital and Clinics Multiple Sclerosis Clinic Fleming, John O MD JEFFERSON

UW Health Regional Specialty Services Fort Memori Tunnell, Evelyn C MD MANITOWOC HFM Manitowoc Health and Rehab Clinic Erlemeier, Steven A MD Holy Family Memorial Family Medicine Erlemeier, Steven A MD Holy Family Memorial Neuroscience Erlemeier, Steven A MD Holy Family Memorial Shady Lane Clinic Erlemeier, Steven A MD NEUROSURGERY/ NEUROLOGICAL SURGERY BROWN Neuroscience Group Brazzale, Kristen A APNP SHAWANO Neuroscience Group Brazzale, Kristen A APNP WINNEBAGO Neuroscience Group Brazzale, Kristen A APNP OBSTETRICS AND GYNECOLOGY DANE UW Health Carbone Cancer Center Wirkus, Jessica L APNP ONEIDA Ministry Medical Group Rhinelander Frimpong, James N MD VILAS Ministry Medical Group Eagle River Frimpong, James N MD ONCOLOGY GREEN LAKE CHN Hematology Oncology Clinic Geller, Robert B MD OPHTHALMOLOGY DANE UW Health University Station Eye Clinic Ophthalmology Girgis, Dalia O MD UW Health East Eye Clinic Ophthalmology Girgis, Dalia O MD UW Health Deming Way Eye Clinic Girgis, Dalia O MD

ORTHOPAEDIC SURGERY BROWN Neuroscience Group Brazzale, Kristen A APNP DODGE Dean Clinic Beaver Dam Family and Sports Orthopaedic Center Damon, Rachel R APNP GREEN LAKE CHN General Surgery Meincke Reza, Jeffrey W MD Community Medical Center of Green Lake Meincke Reza, Jeffrey W MD SHAWANO Neuroscience Group Brazzale, Kristen A APNP WINNEBAGO Neuroscience Group Brazzale, Kristen A APNP Sports Medicine Center SC Lundgren, Laura M PAC PAIN MANAGEMENT MANITOWOC Advanced Pain Management Moore, Wendy L APNP MILWAUKEE Advanced Pain Management Moore, Wendy L APNP SHEBOYGAN Advanced Pain Management Moore, Wendy L APNP WASHINGTON Advanced Pain Management Moore, Wendy L APNP PHYSICAL MEDICINE AND REHABILITATION FOREST Ministry Medical Group Crandon Tan, Hongjing MD LINCOLN Ministry Medical Group Tomahawk Tan, Hongjing MD ONEIDA Ministry Medical Group Riverside Tan, Hongjing MD PLASTIC SURGERY OUTAGAMIE Fox Valley Plastic Surgery SC Serret, Marc A MD WINNEBAGO Fox Valley Plastic Surgery SC NetworkHealthMedicare.com

PORTAGE Oswald Counseling Associates Inc Pflugardt, Shawn A PsyD SHEBOYGAN Bridgepoint Health LLC Woythal, Constance L PsyD PULMONARY MEDICINE

800-378-523 4 TTY 800-947 -3529 NetworkHealt hMedicare.co Monday - Frid m ay, 8 a.m. to 8 p.m.

MAGNETIC RESONANCE IMAGING Excel Orthopedics PHYSICAL THERAPY Current Physical Therapy Community Health Network Rehab

Apria Healthcare No Longer In-Network Effective January 1, 2015, Apria Healthcare will no longer be a participating provider with Network Health’s Medicare Advantage (PPO) plans.

You may continue to work with Apria for durable medical equipment (DME) needs, however you’ll pay the out-of-network amount, which is 50 percent of the cost. If you need help finding a DME provider that’s in-network, to avoid out-of-network costs, call your health care concierge or our customer service department at 800-378-5234, Monday - Friday, 8 a.m. to 8 p.m. (TTY 800-947-3529).

NetworkHealthMedicare.com

Network Health has created a practical guide available to all members to assist with advance care planning. Advance care documents ensure your wishes are honored when you’re receiving care. To access this guide, visit NetworkHealthMedicare.com and click on Member’s Corner. Scroll down until you see the heading Forms. Click on Advance Care Planning/Power of Attorney for Health Care Form. Make sure to print, complete and then share the form with your provider. If you don’t have a computer, call us for a hard copy.

T NE

RK HEALTH ME WO DI C

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OUTAGAMIE Fox Valley Pulmonary Medicine LLC Dellamater, Eric T APNP WINNEBAGO Fox Valley Pulmonary Medicine LLC Dellamater, Eric T APNP RHEUMATOLOGY BROWN Prevea Clinic Mufti, Kashif A MD SPORTS MEDICINE WINNEBAGO Sports Medicine Center SC Lundgren, Laura M PAC

Need Help with Advance Care Planning?

E X T R AE

PSYCHOLOGY-GENERAL

SURGERY GREEN LAKE CHN General Surgery Meincke Reza, Jeffrey W MD Community Medical Center of Green Lake Meincke Reza, Jeffrey W MD KEWAUNEE Holy Family Memorial Lakeshore Medical Specialists Sbar, Alan D MD MANITOWOC Manitowoc Surgical Associates Sbar, Alan D MD UROLOGY GREEN LAKE UW Health UW Hospital and Clinics Gery, Daniella APNP VASCULAR SURGERY COLUMBIA UW Health Regional Specialty Services Portage Clinic Engelbert, Travis L MD DANE UW Health West Clinic Vascular Surgery Engelbert, Travis L MD RICHLAND UW Health Regional Specialty Services Richland Med Ctr Engelbert, Travis L MD

E XC L U S I V

Serret, Marc A MD PSYCHIATRY-GENERAL BROWN Prevea Clinic Sta Romana, Josefina M MD MARATHON Ministry Medical Group Weston Hangiandreou, Gabriella A MD ONEIDA St. Marys Hospital Hangiandreou, Gabriella A MD

PLATINUM PERKS

Enjoy disco unts at local bu throughout northeast Wi sinesses and organiza tions sco Network He alth Medicare nsin just by showing your Y0108_348_09 Advantage 1814 NHIC 09/2 (PPO) ID ca 014 rd.

New Dental Plans and Hearing Aid Offer Good news—in 2015, Network Health Medicare Advantage members will have more choices for dental coverage and an exclusive discount on high-quality hearing aids.* To learn more about the new dental plans and hearing aid offer, visit NetworkHealthMedicare.com/ members/platinum-perks.php (Please note that these dental plans do not apply to NetworkCares (SNP) members. NetworkCares members will continue to have comprehensive dental coverage through IHC Dental.)

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1570 Midway Pl. Menasha, WI 54952 Health or Wellness or Prevention Information

Meet

Kacey Werner and Your Member Advocate Team Top row, left to right – Dawn Mason, Kacey Werner, Kari Kamuda. Bottom row, left to right - Jeanne Skinner and Joi Ahrens

D

id you know that Network Health has a team of dedicated professionals who work together on your behalf? Our member advocates do just that to make sure you have access to the right care.

When a request for a medical service is denied, and a member or doctor challenges the decision (commonly called an appeal), our member advocate team goes to work.

Member Advocate Supervisor, Kacey Werner, explains “It’s our job to help support the member or doctor’s request.” To learn more about how the process works, read our interview with Kacey below.

Q: What is the first thing a member should do if they want to make an appeal?

A: “The first thing a member should do is call customer service. The health care concierge can help them make a verbal appeal. Or, if a member prefers, they can also send in a letter. And, a doctor or provider can always make an appeal at the member’s request.”

Q: What is the next step in the process?

A: “The member advocate team gets the request right away. Soon, the member will receive an acknowledgement letter which provides more information and the status of the appeal.

Q: What does Kacey wish members knew about the member advocate team?

A: “We understand how frustrating it can be when something is denied. We truly empathize with the member.

As member advocates, we want to make sure members are getting the best and appropriate care.”

WHAT’S THAT?

Q: What does Kacey enjoy most about her role as member advocate supervisor?

A: “I’m very happy in my current role—it’s nice to work for a company like Network Health. The dedication to our Medicare members and the length associates will go to help our members is pretty unique. What I enjoy most would have to be knowing I had a hand in helping a member get a service they needed. Any time we can get a necessary service approved, we’re happy about it.”

Q: What are some of the challenges related to her position?

A: “Network Health closely follows Medicare guidelines.

It can be difficult for a member who doesn’t receive approval for a treatment their doctor has suggested, but we want the member to understand all of Network Health’s approval decisions are based on medical data and appropriate care best practices.”

Health Care Concierge Your personal Network Health customer service representative. You can always call this person directly.